1215965397 NPI number — WALLKILL PHYSICAL THERAPY, PLLC

Table of content: (NPI 1215965397)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215965397 NPI number — WALLKILL PHYSICAL THERAPY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WALLKILL PHYSICAL THERAPY, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215965397
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 336
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALLKILL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12589-0336
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-895-9003
Provider Business Mailing Address Fax Number:
845-895-9006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 STATE ROUTE 208
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALLKILL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12589-3712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-895-9003
Provider Business Practice Location Address Fax Number:
845-895-9006
Provider Enumeration Date:
06/29/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SCHNEIDER
Authorized Official First Name:
LORI
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
OWNER/MANAGER, PHYSICAL THERAPIST
Authorized Official Telephone Number:
845-895-9003

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  009042 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1255379525 . This is a "NPI INDIVIDUAL PROVIDER #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 11574902 . This is a "CAQH #" identifier . This identifiers is of the category "OTHER".